The passage of Obamacare is perhaps the most important recent example. By CBO’s 2010 estimates, Obamacare authorized $940 billion in new spending to expand insurance coverage over its first ten years. Congress partly offset these costs with provisions for new revenue like the medical-device tax and the so-called “Cadillac tax” on expensive employer-sponsored plans. To make up the remaining difference, it relied on Medicare changes similar to proposals that had been considered previously in the Senate Finance Committee’s earlier draft of the legislation: changes to physician payments, cuts to Medicare Advantage, and new Hospital Insurance revenues. All told, the actuaries credited Obamacare with $575 billion in net Medicare savings — even as those savings were used to paper over the law’s new spending. These ten-year estimates have changed over time, as the law’s schedule did not provide for full implementation until several years into the initial ten-year budget window.
The Supreme Court in a 6-2 decision on Tuesday struck down Vermont’s requirement that self-funded insurers submit claims data to the state’s all-payer claims database (APCD).FROM OUR EXPERTSUsing claims to analyze physician performance? First, check your data. At issue in the case—Gobeille v. Liberty Mutual Insurance—was whether Vermont could require self-insured employer health plans to provide claims data for the state’s APCD, or whether the federal Employee Retirement Income Security Act (ERISA) prevented the state from doing so.The case has national implications: 18 states have such databases, and about 20 others are considering creating them, according to National Academy for State Health Policy Executive Director Trish Riley.
Trump appears to be borrowing some of the language behind a traditional conservative Republican health reform proposal, which involves facilitating competition in health coverage through the sale and purchase of insurance products across states. It’s sometimes referred to as interstate competition or competitive federalism, or even just “consumer choice.” The origins of this proposal have a history of almost 15 years. Some business groups in the small-group market started floating the outlines of this idea in 2001. I wrote the first draft in policy terms at a Cato conference in July 2001, and subsequently published the academic-style version in the Cato Journal the following year. Then-Rep. Ernie Fletcher (R-KY) proposed the first legislative bill on this front in 2002. Subsequent tweaks to those concepts on Capitol Hill were championed by then-Rep. John Shadegg (R-AZ), and, in later years, by Rep. Tom Price (R-GA) and Rep. Marsha Blackburn (R-TN). Presidential candidate Ted Cruz introduced a bill similar to Blackburn’s in the U.S. Senate.